Royal Leamington Spa Canoe Club Membership form
Welcome to Royal Leamington Spa Canoe Club, please can we ask that you fill the form in and pay your membership at the same time. If you require assistance, please email the membership secretary Janet Harris via membership@rlscc.co.uk

12 Month renewals payable before February 2018. There is a late payment charge of £21 if the 12 month renewal is paid after February.

Please complete 1 form for each membership application

To pay by bank transfer:
SORT CODE: 20-48- 08
ACCOUNT NO: 60768340
REFERENCE: (Surname / Forename), we will then be able to identify the transaction and match it with the membership form.

Email address *
Personal Details
Please complete all details.
Forename *
Your answer
Surname *
Your answer
1st line of Address *
Your answer
2nd line of Address *
Your answer
Town / City *
Your answer
Postcode *
Your answer
Phone number *
Your answer
British Canoeing Membership No. & Renewal Date
Your answer
Age at 1st Jan 18 *
Your answer
Emergency Details
Emergency contact name *
Your answer
Emergency contact number *
Your answer
Membership Fees
SENIOR (18 or over at the 1st Jan 18) JUNIOR (Must be between 11 - 18 yrs , MUST ADD YOUR PARENT AS A SOCIAL MEMBER) FAMILY: Dependant Junior (u18) of a senior member ASSOCIATE: Living> 25 miles away or full time student SOCIAL: Non paddling supporter or supporting Junior member
*
Gym membership (must be a Senior member & over 18 years old to have 24 hr access. Junior training sessions do not fall under this option.)
KEY FOB - ACCESS TO THE CLUB
Requires a £20 deposit
Do you have a key fob to access the building?
If not, do you require a key fob to access the building?
Boat storage
Members paying "WITH boat storage" fee may (space permitting) store a K1 / C1 boat at RLSCC.
Extra racks may be available subject to an extra charge (£30.00 per boat). Unregistered and non-membership boats may be used for club purposes or removed and sold to recover costs.
Description, deck and hull colour of 1st boat to be stored.
Your answer
Extra rack if required: Description, deck and hull colour
Your answer
Extra rack if required: Description, deck and hull
Your answer
Total cost membership for 2018 including gym & extra rack fees (please add all your costs up and insert here) *
Your answer
Declaration
I understand and agree, that canoeing / kayaking and any use of the club gym is undertaken at my own risk and I will abide by the club rules. I confirm that I do not suffer any disability or medical condition which may render me unfit for strenuous exercise (should a medical condition exist, this will not necessarily preclude you from membership/participation, but it must be it must be declared in writing). Should you be in any doubt, advice should be sort from your family doctor.

A parent or guardian must submit this form on behalf of members under the age of 18 on 1st January 2018

Data Protection Act 1998: The details provided will only be used in connection with your application for membership and activities associated with RLSCC. The club will store the details given in an electronic database for monitoring, mailing and accounts purposes.

Thank you for your membership

Agree to declaration *
A copy of your responses will be emailed to the address you provided.
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